椎基底动脉供血不足的彩色多普勒超声诊断

Color Doppler ultrasonography for clinically diagnosing vertebrobasilar arterial blood-supply insufficiency

目的探讨彩色多普勒超声对椎基底动脉供血不足的临床应用价值。方法对85例临床表现为反复头晕等椎基底动脉供血不足症状患者和对照组68例应用彩色多普勒超声检测其双侧椎动脉走行、管腔内有无粥样斑块形成、各椎间段的内径及血流动力学指标,包括最大血流速度(Vmax)、阻力指数(RI)、搏动指数(PI),血流量(Q),其中35例行数字减影血管造影(DSA)检查11例诊断为椎动脉起始段狭窄。经内科治疗和外科支架置入术后,复查上述指标。结果颈椎间盘突出导致椎基底动脉供血不足的超声表现为:椎动脉在椎间的走行迂曲,内径减小,血流量减低;椎动脉狭窄导致椎基底动脉供血不足的超声表现为椎动脉起始段粥样斑块形成,内径减小,血流量明显减低;各种原因导致的椎基底动脉供血不足均表现为椎动脉血流量的减小,经内外科治疗后椎动脉血流量有所改善。结论彩色多普勒超声可用于诊断各种原因导致的椎基底动脉供血不足,椎动脉的血管走行和血流量可作为椎基底动脉供血不足的客观诊断指标和疗效评价指标。

Objective To evaluate the value of color Doppler ultrasonography in clinical diagnosing vertebrobasilar arterial blood-supply insufficiency. Methods Eighty-five patients with clinical manifestations of recurrent vertigo of vertebrobasilar blood-supply insufficiency and 68 controls were subjected to color Doppler ultrasound detection of the courser of bilateral vertebral artery and atherosclerotic plaque formation in lumens, the intervertebral section inner diameter and hemodynamic indices including： the maximum velocity （Vmax）, resistance index （RI）, pulsatility index （PI）, blood flow （Q）, also including 35 cases to digital subtraction angiography（DSA） examination and 11 patients a diagnosed as vertebral artery origin stenosis. Through medical therapy and surgical stent implantation, the above indexes were reexaminated. Results The uhrasonography results of cervical intervertebral disc herniation leaded vertebrobasilar artery blood-supply insufficiency were： vertebral artery in the intervertebral along the tortuous, diameter reducing, blood flow significant decreased; in the stenosis of the vertebral artery leaded vertebrobasilar artery blood-supply insufficiency the ultrasound findings were proximal vertebral artery atheromatous plaque formation, inner diameter reducing, blood flow significantly reduced. Vertebrobasilar blood- supply insufficiency induced from various causes all showed vertebral artery blood flow decrease, after medicine and surgical treatment vertebral artery blood flow became improvement. Conclusion Color Doppler ultrasound can be used for diagnosing vertebrobasilar blood-supply insufficiency induced from various causes, vertebral artery blood flow and courser can be used as objective diagnostic index and effect evaluation for vertebrobasilar insufficiency.